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Ginecología y Obstetricia de México

Federación Mexicana de Ginecología y Obstetricia, A.C.
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2020, Number 04

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Ginecol Obstet Mex 2020; 88 (04)

Doubble Trigger in patients with a normal response with a low percentage of mature oocytes

Kably-Ambe A, Olavarría-Guadarrama MY, Carballo-Mondragón E, Roque-Sánchez AM, Durán-Monterrosas LÁ, Sánchez-Aranda A, Brito-Sandoval F
Full text How to cite this article

Language: Spanish
References: 9
Page: 244-251
PDF size: 214.91 Kb.


Key words:

Double trigger, In vitro fertilization, GnRH agonist, Oocyte maturation, hCG.

ABSTRACT

Objective: To evaluate the effect of double trigger in patients with a previous cycle with less than 65% of mature oocytes compared to the captured oocytes, in a normorresponding population with induction of ovulation with recombinant or urinary hCG.
Materials and Methods: A prospective cohort study, conducted in patients diagnosed with infertility, treated with in vitro fertilization, evaluated at the Mexican Fertility Center (Hospital Angeles Lomas) between 2017 and 2019. The treatment was carried out in the same patient, in whose previous conventional cycle with antagonist scheme and induction of ovulation with hCG had suboptimal ovarian response and oocyte capture with less than 65% in M2 phase (Group 1). Subsequently, a second cycle was performed with the same scheme of gonadotropins and induction of ovulation with double shot: 1 mg triptorelin acetate + 5000 IU of urinary hCG 40 and 34 hours prior to capture (Group 2 or double trigger). Percentage and quantity of oocytes captured in M2 phase were evaluated.
Results: 34 patients were registered, in whom 68 cycles were performed. The number of oocytes captured was greater in group 2 (agonist of GnRH + urinary hCG; p = 0.03). The double shot increased the percentage of mature oocytes 65.4 ± 21.3 vs 74.6 ± 20.2 (p = 0.07).
Conclusions: The double trigger technique is valuable for the treatment of patients with poor oocyte capture, even with normal follicular development and adequate and optimal hCG estradiol concentrations on the day of capture. Large prospective studies are required to elucidate the aforementioned recommendation of the “double shot” technique.


REFERENCES

  1. Griffin D, et al. Dual trigger with gonadotropin-releasing hormone agonist and standard dose human chorionic gonadotropin to improve oocyte maturity rates. Fertil Steril. 2014;102:405-9. doi: 10.1016/j.fertnstert.2014.04.028.

  2. Lin M, et al. Dual trigger with combination of gonadotropin- releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles. Fertil Steril 2013;100(5):1292-302. doi: 10.1016/j.fertnstert. 2013.07.1976.

  3. Oliveira S, et al. Final oocyte maturation in assisted reproduction with human chorionic gonadotropin and gonadotropin- releasing hormone agonist (dual trigger). JBRA Assist Reprod 2016;20(4):246-250. doi: 10.5935/1518- 0557.20160047.

  4. Haas J, et al. Standard human chorionic gonadotropin versus double trigger for final oocyte maturation results in different granulosa cells gene expressions: a pilot study. Fertil Steril 2016;106(3):653-659. doi: 10.1016/j.fertnstert. 2016.06.002.

  5. Youssef MA, et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonistassisted reproductive technology. Cochrane Database Syst Rev 2014;10:CD00804. doi: 10.1002/14651858. CD008046.pub4.

  6. Kasum M, et al. Combined ovulation triggering with GnRH agonist and hCG in IVF patients. Gynecol Endocrinol 2016;32(11):861-865. doi: 10.1080/ 09513590.2016.1193141.

  7. Lamb JD, et al. Follicle-stimulating hormone administered at the time of human chorionic gonadotropin trigger improves oocyte developmental competence in in vitro fertilization cycles: a randomized, double-blind, placebo-controlled trial. Fertil Steril 2011;95:1655-60. doi: 10.1016/j.fertnstert.2011.01.019.

  8. Zilberberg E, et al. Co-administration of GnRH-agonist and hCG, for final oocyte maturation (double trigger), in patients with low proportion of mature oocytes. Gynecol Endocrinol 2015;31:145-7. doi: 10.3109/09513590.2014.978850.

  9. Haas J, et al. Co-administration of GnRH- agonist and hCG for final oocyte maturation (double trigger) in patients with low number of oocytes retrieved per number of preovulatory follicles–a preliminary report. J Ovarian Res 2014;7:77–82. doi:10.1186/1757-2215-7-77.




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Ginecol Obstet Mex. 2020;88